Individual
JOHNNY SADLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2847 HIGHWAY 178, TUPELO, MS 38804-9606
(662) 205-4630
Mailing address
2487 HWY 178 EAST, TUPELO, MS 38804
(662) 205-4630
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
R729388
MS
Other
Enumeration date
06/02/2015
Last updated
06/02/2015
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